The Business Consultant is responsible for facilitating regulatory audits that involve the Prior Authorization process. The facilitation of each audit includes, but is not limited to, determining data requirements, providing deliverables timely, presenting cases and answering process related questions during the audit. The applicant will possess full technical knowledge of the Prior authorization systems in order to identify deficiencies proactively, ahead of the audit. This position will specifically be responsible for handling Prior Authorization audit requests, and regulatory reporting for Medicare part D.
Location: This position will work a hybrid model (1 day in the office per week). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
How you will make an impact:
Work with our internal operations teams to understand current workflows and where improvements can be considered.
Create reports for leadership around key performance indicators.
Evaluate audit requirements.
May lead teams of analysts assigned to complex projects.
Determine audit risks.
Analyze audit findings and regulatory reporting.
Consult with business partners concerning audit findings to determine root cause/remediation.
Minimum Requirements:
Requires a BA/BS and minimum of 8 years business analysis experience, which should include analysis and project management; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
Knowledge of systems capabilities and business operations strongly preferred.
Knowledge of SQL and/or Alteryx strongly preferred.
Experience working with Medicare part D.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.
